Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycin for carcinoma of the esophagus

Roth, Jack A.; Pass, Harvey I.; Flanagan, Margaret M.; Graeber, Geoffrey M.; Rosenberg, J. C.; Steinberg, Seth M.

doi:10.1016/s0022-5223(19)35265-1

Cited by 373 publications

(102 citation statements)

References 12 publications

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“…Kelson et al 4 reported a 63% response rate with a cisplatin/vindesine/bleomycin combination. Similar studies by Schlag et al 5 and Roth et al 6 had 45% and 47% response rates respectively. Carey et al 7 reported a 64% response rates with the regimen used at our center with a 39% complete remission rate, and a 31% 5-year overall survival.…”

Section: Discussionsupporting

confidence: 80%

Neoadjuvant chemotherapy before surgery for resectable carcinoma of the lower esophagus

Jonker

Mehran

Maroun

et al. 1999

Diseases of the Esophagus

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Neoadjuvant chemotherapy before surgery has been proposed to improve the outcome in patients with early lower esophageal cancer. To evaluate its effectiveness, we performed a systematic retrospective analysis of consecutive patients treated at the Ottawa Regional Cancer Center with prospective inclusion criteria. Between 1988 and 1992 patients were treated with surgery alone. From 1992 until 1997, patients were uniformly treated with neoadjuvant chemotherapy consisting of cisplatin and 5-fluorouracil. Surgical resection was then performed. Nineteen patients received neoadjuvant chemotherapy and 15 received surgery alone. Although the two arms of the study were balanced for age and sex, there were more patients in the neoadjuvant arm with squamous histology, weight loss and regional nodes at diagnosis. In the neoadjuvant arm, two patients did not have surgery because of progression or toxicity. However, complete resection rates were similar. There was no difference in overall survival or disease-free survival between the two arms (p > 0.4). Multivariate analysis revealed that only the nodal status at diagnosis was predictive of outcome. Neoadjuvant chemotherapy with this regimen does not result in improved survival over surgery alone.

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Section: Discussionsupporting

confidence: 80%

Neoadjuvant chemotherapy before surgery for resectable carcinoma of the lower esophagus

Jonker

Mehran

Maroun

et al. 1999

Diseases of the Esophagus

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“…Complete response to chemotherapy demonstrated by no residual tumour in the pathological specimens clearly has an impact on treatment survival, which was significantly longer than that of nonresponders and patients who underwent surgery alone [16,22]. Two of our patients had complete clinical response by esophagography and endoscopy; however, viable tumour was found histopathologically, in both patients, so that no truly complete response was obtained in this study.…”

Section: Discussionmentioning

confidence: 60%

“…Schlag et al [21] used the same drugs on a somewhat different DVB regimen and obtained a response rate of 44%. Preoperative DVB chemotherapy is also currently being evaluated at the National Cancer Institute, with a response rate of 50%, and the postoperative complication rate was lower for patients receiving chemotherapy than for patients having immediate surgery [22]. Although there is no statistically significant difference between the actuarial survival curves for the chemotherapy plus surgery and the control surgical group, the survival of the patients responding to chemotherapy was significantly longer than that of the patients in the surgical group.…”

Section: Discussionmentioning

confidence: 99%

Induction chemotherapy in the treatment of patients with carcinoma of the esophagus

Maipang

Vasinanukorn

Petpichetchian

et al. 1994

Journal of Surgical Oncology

128

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A prospective randomized phase III trial was carried out at Songklanagarind Hospital from August 1988 to December 1990. The objectives of the study were to evaluate the effect of chemotherapy regimen in squamous cell carcinoma of the esophagus and to determine whether induction chemotherapy improves symptom-free period and survival in these patients compared to surgical treatment alone. Twenty-four patients were randomized to receive 2 cycles of chemotherapy, cis-platinum 100 mg/m2 intravenously on day 1, bleomycin 10 mg/m2 loading dose on day 3, followed by 10 mg/m2/day continuous intravenous infusion on days 4 through 7, and vinblastine 3 mg/m2 given intravenously on days 1, 8, 15, 22. The cycle was repeated on day 29. Fifteen patients completed 2 courses of chemotherapy and among these, 2 patients had a complete clinical response (13%), 6 (40%) had a partial response, and 7 patients (47%) had no response. Four patients died during chemotherapy treatment. Grade 3 hematologic toxicity (ECOG criteria) was observed in 47% (7/15) of patients. Twenty-two patients were randomized to conventional treatment (surgery alone). Median survival time was 17 months in both groups. However, early survival appeared to be better in the control group. Kaplan-Meier survivals at 6 months were 69% and 89% and at 3 years were 31% and 36% for the induction chemotherapy group and control group, respectively. The survival time differences were not statistically significant (P = 0.186). These findings demonstrate that although this chemotherapy regimen had some effect on squamous cell carcinoma of esophagus, it did not improve survival. On the contrary, survival seems to be better in the control group. The 6-month survival discrepancy between both groups might be due to the poor nutritional status of our patients, who may better tolerate smaller dosages of chemotherapy.

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“…12 When a similar regimen has been used in trials of patients with SCC of the esophagus, pathological response rates of 40-50% have been reported. [8][9][10][11] The lack of a significant response (TRG 1 or 2) in our group of patients with AC suggests that primary AC of the esophagus may not be as responsive to the neoadjuvant chemotherapy that is presently used for this disease. For patients who had chemoradiation therapy, the pathological complete response rate of 5% in this series was similar to that reported in a recent multi-centered study of neoadjuvant chemoradiation therapy where patients received a single cycle of the same drugs and the same radiation dose.…”

Section: Discussionmentioning

confidence: 76%

“…7 Those who do not respond to neoadjuvant therapy have significantly inferior outcomes. [8][9][10][11] The largest trial of neoadjuvant chemotherapy in patients with esophageal cancer demonstrated a significant survival advantage at 2 years. 12 A recent meta-analysis of neoadjuvant therapy reported an absolute 2-year survival advantage of 7% with neoadjuvant chemotherapy and 13% with neoadjuvant chemoradiation therapy in patients with esophageal carcinomas, compared to those treated by surgery alone.…”

Section: Introductionmentioning

confidence: 99%

Positron emission tomography and pathological evidence of response to neoadjuvant therapy in adenocarcinoma of the esophagus

et al. 2008

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Our aim was to determine if fluorodeoxyglucose positron emission tomography (FDG-PET) could be correlated with a pathological response in patients with esophageal adenocarcinoma receiving neoadjuvant chemotherapy and/or chemoradiation therapy. Patients with resectable, histologically proven adenocarcinoma of the esophagus were entered in the study. Preoperative chemotherapy comprised two cycles of cisplatin and 5-fluorouracil. Radiation therapy commenced with the second cycle on day 22. FDG-PET images were obtained pre-treatment and on completion of intended neo-adjuvant treatment. Quantification was achieved by the calculation of both standardized uptake values (SUV) and tumor/liver ratios (TLR). Evidence of histopathological response was identified according to the Mandard tumor regression scoring system. There were 45 patients, 22 receiving neoadjuvant chemotherapy and 23 chemoradiation therapy. Forty patients underwent surgical resection. Seven patients (16%) had a histopathological response. The mean percentage change in SUV in the histological responders group was -56.8% (SD 29) and in the non-responders -27.8% (SD 32.1) (P = 0.035). The mean percentage change in TLR was -49.1% (SD 44.8) in the responders and in the non-responders -27.3% (SD 31.3) (P = 0.128). There was no difference between the two methods of assessment, however there was less variation with SUV. There was no correlation between the FDG-PET response and the histopathological response. Presently an FDG-PET scan performed 3-6 weeks after neoadjuvant therapy for adenocarcinoma of the esophagus should not be used as a marker of the potential result of the treatment. The optimal timing of a second FDG-PET remains unclear.

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Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycin for carcinoma of the esophagus

Cited by 373 publications

References 12 publications

Neoadjuvant chemotherapy before surgery for resectable carcinoma of the lower esophagus

Neoadjuvant chemotherapy before surgery for resectable carcinoma of the lower esophagus

Induction chemotherapy in the treatment of patients with carcinoma of the esophagus

Positron emission tomography and pathological evidence of response to neoadjuvant therapy in adenocarcinoma of the esophagus

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